Efforts to Sustain Asthma Home
Visiting Interventions in
Massachusetts
Jean Zotter, JD
Director, Office of Integrated Policy, Planning
and Management
and Terry Mason, PhD Consultant
MA Background
• CHW Policy
– MA Health Care Reform law - 2006
• Tasks MA DPH to conduct CHW workforce study
• Study released 2010
– CHW certification law – 2010
• Asthma CHW Best Practice Development
– Boston Public Health Commission
– Children’s Hospital Boston
– Mass Department of Public Health: READY Study
• Boston Medical Center & Baystate Medical Center
Massachusetts Health Care Landscape
• Moving away from fee-for-service (FFS)
reimbursement
– By 2015 will be 80% global payment – public and
private insurers including Medicaid
• States will need to understand how their Medicaid
Office is funding preventive services to focus on
coverage
Current Infrastructure
• Training and support developed and implemented for
MDPH by Boston Public Health Commission’s CHEC
Program
– Included:
• Comprehensive Outreach Education Certificate Program
offered by CHEC
• 4 Day Asthma Home Visitor Training developed by CHEC, 2
day “refresher” training annually
• 2 day Supervisor Training
• Quarterly in-person support meetings
• Study protocols, educational materials, health outcomes
measurement, high-risk definition
Insurer Perspective
• Response from Insurers to Asthma CHW Intervention
– Openness to payment
• Some convinced it works
• Some still need more cost benefit analysis
• To expand reimbursement wanted:
– Standardized training
– Standardized skill assessment/evaluation
– Easy referral system
Opportunities - Moving Towards
Coverage
Health Reform
• CMS Innovation Grants
• Medical Homes, Health
Homes, Dual Eligibles
• Bundled or Global
Payments
• Accountable Care
Organizations
• Hospital Community
Benefits
• CMS Ruling
State/Local Infrastructure
• CHW certification
• CHW training
CMS Ruling
• Permits states to reimburse for Medicaid
covered preventive services delivered by nonlicensed providers if “recommended by a
physician or other licensed provider”
– Effective Jan 2014
– State Medicaid Agency must submit a
State Plan Amendment
Current Initiatives for Sustainable
Funding in MA
• MassHealth Children’s High Risk Asthma
Bundled Payment (CHABP) Pilot Project
– Legislatively mandated
– Establishes a bundled payment system for currently unreimbursed
asthma mitigation services - Phase 1, with goal of establishing
comprehensive bundled payment for asthma care - Phase 2
– Engages limited pilot sites and targets high-risk pediatric asthma
patients; designed to prevent hospital admissions and emergency
room utilization
– Approved by CMS via 1115 waiver
– Program cost and outcome evaluation will be used to explore
further program expansion
Current Initiatives for Sustainable
Funding in MA
• Health Resources in Action’s New England Asthma
Innovations Collaborative: CMS HCIA Award
• New England Initiative lead by Asthma Regional Council of
New England
• Program Components:
• Asthma Education and Home Visiting Service delivery expansion
(1136 children)
• Workforce development
• Committed Medicaid payers
• Payer and Provider Learners Community
• Policy goal: sustainable payment system, 3 MA insurers
committed to covering if ROI demonstrated, total 4 MCOs and
6 Medicaid programs in NE participating
Current Initiatives for Sustainable
Funding in MA
• MDPH’s Prevention and Wellness Trust
– $60 million fund established by state
legislature in 2012
– Pediatric asthma is one of four priority
conditions
– Program Components for High-Risk Asthma:
• Clinical: care management
• Home: asthma home visits
• Schools: comprehensive school-based education
programs
The Road Ahead
• CMS Ruling – opportunity for coverage
• For MA:
– Standardize home visit protocols, health
outcome measures, educational key
messages, high-risk definition
– Expand training: geographically, mentoring
component, skill assessment, teen module
– Support QI for home visits
– Promote business case for home visits to
insurers and provider groups
APCP’s Funding Support for CHW Work
• This presentation was supported by the federal
agencies listed below. The content of the
presentation is solely the responsibility of the
presenter and does not necessarily reflect the views
of those agencies:
– National Institute of Environmental Health Sciences (NIEHS);
R01 ARRA Award; READY Study; #5R01ES017407-02
– Housing and Urban Development; Healthy Homes Technical
Studies Award; READY2 Study; #MALHH0227-10
– Centers for Disease Control and Prevention; National Center
for Environmental Health; Addressing Asthma from a Public
Health Perspective; #5U59EH000501
Contact Information and Resources
Jean Zotter, jean.zotter@state.ma.us, 617-994-9807
• APHA Community Health Worker Section
http://www.apha.org/membergroups/sections/aphasections/ch
w/
• MDPH Office of Community Health Workers
http://www.mass.gov/dph/communityhealthworkers
• CDC E-Learning CHW
http://www.cdc.gov/dhdsp/pubs/chw_elearning.htm
• Seattle King County CHW Resources
http://www.kingcounty.gov/healthservices/health/chronic/asth
ma/resources/tools.aspx
• Asthma Prevention and Control Program
www.mass.gov/dph/asthma